For many years, the healthcare industry has discussed the shift to value-based care, and what this transition would look like for payers, providers, and patients. According to the U.S. Department of Health and Human Services, 59% of healthcare payments are currently tied to value-based care or pay-for-performance (P4P) models.
The paradigm shift to value-based care is long overdue. Providers need to focus on the quality of care given to each patient, instead of looking at them as dollar signs. The P4P model provides incentives for individual performance goals in terms of efficiency, while also penalizing those who have poor patient outcomes, medical errors, and high costs.
The aggressive and rampant spread of COVID-19 throughout our healthcare system has forced the industry to evolve, as seen with the significant increase in the utilization of telemedicine and virtual care.
In fact, COVID-19 is accelerating the transition to value-based care, as the pandemic has exposed how vulnerable the current system is financially, especially in times of crisis like this.
In order to continue this shift towards value-based care, the following must occur:
• Develop and distribute a centralized, agile value-based care delivery model
• Shift the payment paradigm
• Change provider and patient behavior
Build the Foundation
One of the biggest obstacles in the way of moving to value-based care is the complex, outdated systems care providers are still using across the country. A centralized and flexible value-based care model needs to be constructed that can easily integrate with current systems. This new care delivery model would move away from fee-for-service and outline new measures of success that care providers can easily follow.
The COVID-19 pandemic has demonstrated the many flaws within the current system. A Dallas-based Merritt Hawkins survey found that 21% of physicians have been furloughed or experienced a pay cut, 14% plan to change practice settings as a result of COVID-19, and 18% plan to retire, temporarily close their practices or opt-out of patient care. By billing for treatment upfront or developing a monthly rate for patient care, providers can have a more stabilized income stream while expanding the continuum of care for patients.
Furthermore, such a model would not only simplify care, but it would help decrease the amount of time spent on the administrative paperwork.
A 360-degree approach to data collection and utilization will be critical in developing this new model. Combining smart wearables with real-time data collection of key metrics, such as nutrition, vitals and medication intake, will help paint a more complete photo of patient health for providers. Home activity sensors and BLE tags are other forms of smart technology can be used to collect patient data. It is important that data collection methods are safe and secure, and turn these measures into actionable insights for both the provider and patient. Creating this smart ecosystem helps promote self-care while improving health outcomes and lowering costs.
Ensuring the new care delivery model is flexible and easy to integrate is a must if we want value-based care to be widespread. The model needs to be user-friendly and streamlined, as providers already spend too much time on billing, patient files, and other forms of administrative paperwork. In fact, the new model should strive to significantly decrease this time, to allow care providers to focus more on patients. Additionally, the new platform would need to include telemedicine, remote patient monitoring and other forms of virtual care as the increased adoption rate of these solutions will continue to be used post-pandemic. Housing all of these capabilities into one central portal is critical to help save time and money.
Additionally, the new platform would need to include telemedicine, remote patient monitoring and other forms of virtual care as the increased adoption rate of these solutions will continue to be used post-pandemic. Housing all of these capabilities into one central portal is critical to help save time and money.
Eliminating Payment Perplexities
Let’s face it. Healthcare is expensive and costs continue to rise. In fact, healthcare costs are expected to reach nearly $6 trillion, approximately 20% of our nation’s GDP, by 2027. Balancing affordability and enhanced quality of care is a tricky scale and one that can be a financial risk.
However, there are alternatives to the traditional payment models that have grown in popularity over recent years.
Direct primary care and concierge care are options that simplify both the payment and care process for patients. A study conducted by the Journal of the American Medical Association found that enhanced care coordination can improve cost savings up to $296 per member per month.
The value-based care delivery model needs to incorporate a payment component that is simple for all parties involved. By establishing a standard set of KPIs, physicians can save time and patients will not be surprised by hidden fees. Such metrics could include:
• Cost per revenue per treatment
• Cost or revenue per patient
• Revenue expense per location
• Revenue expense per referral
• P&L by contract
• P&L by budget
• P&L by location
• 30-day readmission rates
• Emergency room visits
Evolving the Patient-Provider Relationship
The biggest challenge in moving towards value-based care is changing how care providers and patients view healthcare and how it is conducted. For providers, the most significant mental shift will be focusing on the quality of patient care over the number of patients seen. One of the biggest benefits of value-based care is that it enables
providers to stop playing a numbers game and focus on forming better relationships with their patients. These deeper, more long-term relationships will also help providers conduct a higher standard of care for their patients, and perhaps pick up on small nuances they would not have otherwise noticed in the current day-to-day rush of getting through a patient list. The in-person patient-provider relationship can be fostered outside of the office through virtual care and remote patient monitoring technology.
These tools allow providers to continue to manage a patient’s chronic health conditions and monitor for any new developments.
From a patient’s perspective, one of the biggest changes will be establishing a series of behaviors that are more proactive rather than reactive for their health. This behavior change will be key in stopping chronic conditions such as diabetes or heart disease developing in the first place. Furthermore, technology is also a key resource on this
side of the equation to help foster the patient-provider relationship through virtual care and telemedicine.
A value-based care model is a win-win for healthcare providers and patients. The time to make the change is now, as we have the technology available to make this transition a success.
Value-based care provides benefits for those involved in each step of the healthcare continuum, and can be the key to remedying our fragmented health system. This approach to care re-centers the industry focus on what’s most important – our patients.
Building a centralized and agile care delivery model, shifting the payment paradigm and evolving the patient-provider relationship is easier said than done. However, VitalTech is already leading the charge and helping physicians and hospital systems across the country start the journey towards value-based care.
Contact VitalTech today to learn more!